Headaches in Children

 

What is a headache?

A headache is a constant pain anywhere in the head or face area. Headache is one of the most common complaints of children and teenagers. There are 2 different types of headaches:

  • Primary headaches: can occur on their own
  • Secondary headaches: occur as a symptom of a condition

A detailed medical history and physical exam will help the doctor figure out what kind of headache your child has.

What are the different types of primary headache disorders?

  • Tension-type headache - It is the most common type of headache in adolescents. Emotional and mental stress are often factors in causing pain related to tension headaches. The pain is mild to moderate, and feels like pressure or constant band-like pain. It might occur once in a while or occurs daily or more than 15 days every month
  • Migraine - A severe and disabling headache. It can last for hours or days along with nausea, vomiting, sensitivity to light, sensitivity to sound, and dizziness.
  • Cluster headaches - Cluster headaches are uncommon in children but can rarely occur in adolescents. Cluster headaches usually occur in groups of recurring headaches that may last weeks or months. It may disappear completely for months or years, but can come back without any warning. Pain from a cluster headache is severe, sharp, and stabbing on one side of the head. The eye on the affected side (side with the pain) may have a droopy, red or swollen eyelid and small pupil.
  • New daily persistent headache - When a child or teenager has no past history of headaches then suddenly develops chronic headaches.
  • Post-traumatic headache - A headache that starts on a daily basis after a mild head injury or concussion. It usually produces symptoms similar to a chronic migraine.

What causes headaches?

Secondary headaches are caused by physical problems of the brain or a health condition. Most secondary headaches are caused by a viral infection such as the common cold. Common non-infectious causes may include sleep deprivation, depression or caffeine withdrawal. Very rarely, secondary headaches are due to a serious cause such as a brain tumor or bleeding in the brain.

What are the symptoms?

When a child is too young to describe how or where they hurt, fussiness, crankiness and inability to sleep may be the only signs of head pain in young children.
It is important to be aware of symptoms or risk factors that may suggest a more serious underlying cause of the headache. This may include:

  • Very young children
  • A child that is awakened by a headache or experiences pain early in the morning
  • Headaches that get worse with straining, such as coughing or sneezing
  • Frequent vomiting especially projectile and early morning vomiting
  • Sudden, severe or non-stop pain
  • Vision that gets worse including seeing double
  • New weakness of any body part

How is it diagnosed?

A detailed medical history and physical exam is important to diagnosing your child’s type of headache. The doctor will ask questions about:

  • Time the headache occurs
  • How long it lasted
  • Sensitivity to light and/or sound
  • Location of the pain and other symptoms
  • Triggers and what helps relieve the headache
  • Other associated symptoms (nausea, vomiting, visual changes)

Remember: it is very useful to keep a record of all headache episodes that occur over a few weeks before your child’s appointment.
A physical exam and a detailed family medical history will also be used to help make a diagnosis. Based on the medical history and exam, more tests may be ordered. Tests may include:

  • Blood tests
  • Lumbar puncture (spinal tap)• Brain imaging (CT scan or MRI)

How is it treated?

Treatment will depend on the type and cause of the headache; age of the child and medical history. Using the information gathered from the medical history and physical exam, your child’s doctor will develop a custom treatment plan.
For some children, the best treatment for a mild, occasional headache is rest. You can give your child pain medicine such as ibuprofen or acetaminophen according to dosing information for pain relief. It is important not to give pain medicine too often because it may cause your child’s headaches to be worse and more frequent.

How is it treated?

Treatment will depend on the type and cause of the headache; age of the child and medical history. Using the information gathered from the medical history and physical exam, your child’s doctor will develop a custom treatment plan.
For some children, the best treatment for a mild, occasional headache is rest. You can give your child pain medicine such as ibuprofen or acetaminophen according to dosing information for pain relief. It is important not to give pain medicine too often because it may cause your child’s headaches to be worse and more frequent.

When to get emergency care?

Take your child to the emergency room right away if your child has:

  • New sudden onset of severe head pain
  • Sudden, severe head pain with:
    • A change in vision
    • Confusion
    • Too much sleepiness
    • Numbness, new weakness
    • Projectile vomiting (vomiting that shoots out of the mouth)
  • Headache with a stiff neck
  • Complains of neck pain
  • Neck pain with a fever (temperature of 38.5 degrees Celsius /100.4 degrees Fahrenheit or higher)